Esophageal dysphagia is a swallowing disorder caused by problems within the esophagus (food pipe). Esophageal disorders, especially ones that contribute to swallowing problems, affect more than 15 million Americans of all ages.
According to the US Department of Health and Human Services, over 60 to 70 million people suffer from digestive diseases. The CDC (Centers for Disease Control and Prevention) reports the number of Americans who died from gastroenteritis (inflammation of the intestinal linings) more than doubled between 1999 and 2007.
So what is going on with our guts?
Many health experts are now saying commercialized food may be part of the blame. Gone are the days when families primarily relied on locally produced food from farmers or even their own land. Food has been transformed by mass producers such as Nabisco, Oscar Mayer and Chef Boyardee to name a few. We no longer recognize most of the ingredients on these products, yet we put it in our mouth anyways. The effects of food mixed with chemicals in our bodies are finally rearing its ugly head.
When I started working at a large outpatient center in 2010, I did not see too many cases with esophageal dysphagia. Over the past 10 years I have personally seen this more than double within the patients I treat for swallowing disorders. Shockingly, most of them had no idea that their gut was playing a major role in their problems. When contents from the stomach surge back up (or reflux) into the esophagus the damage can become irreversible if left untreated over a long period of time. The average person will have up to 73 reflux episodes per day. What consitutes a problem is the following:
- What is being refluxed? (acid, bile, pepsin, etc)
- How far is the reflux going? (Outside the esophagus into the larynx is atypical)
- How often? (If more than 80 times per day, this is atypical)
If the refluxed contents are highly acidic, they can alter the physiology of the lining within the esophagus resulting in abnormalities such as strictures or Barrett’s esophagus. Barrett’s esophagus is a high risk factor for cancer. Most people assume that reflux is not happening if they do not have heartburn, and therefore ignore some of the less obvious symptoms. In fact, over 40% of people with reflux report no symptoms of heartburn at all. Other sypmtoms may include belching with meals, hiccups, hoarse voice and/or stomach upset to name a few.
So how can we avoid a future filled with painful digestive issues that ultimately lead to a dysfunctional swallow? Above all things, always listen to your gut. If there is any discomfort your body is trying to tell you something. Be proactive. Learn what foods your body responds well to and what it doesn’t. Read about nutrition and learn about the foods you are currently eating. There are many foods that can cause inflammation in the gut such as legumes (due to lectins), grains (due to gluten), too much sugar (inflammatory) and dairy (due to whey, casein, and/or lactose intolerance) to name a few. A good nutritionist that looks at potential food sensitivities and lab work can be an excellent resource. A book my nutritionist highly recommends is “Food: What the heck should I eat?” by Dr. Mark Hyman. Another aspect of acid reflux has been investigated concerning consuming acidic foods (under 5 pH). It’s belived that the consumption of overly acidic foods contributes to refluxing higher acidic contents as well as a very strong enzyme called pepsin. Pepsin is meant to break down the protein we consume for healthy absorption into our body. Our body naturally releases pepsin when we eat due to the activation of Hydrochloric acid (HCL). This release of HCL activates the pepsin for the digestion of our meal. By consuming things such as wine or sodas that are highly acidic, we are releasing pepsin in our body with nothing around for it to break down. Remember it’s sole job is to break down the proteins in our foods. So with the pepsin being activated combined with “normal” reflux events…we are now introducing a harmful enzyme into the esophagus where it does not belong. A great book to read regarding this is by Dr Jonathan Aviv, “The Acid Watcher Diet: A 28-Day Reflux Prevention And Healing Program”.
That being said, always discuss any major diet changes or adding supplements with a doctor that you trust because what is good for one person may not be good for you. We are all complex machines and there is no one manual that is right for everyone. So study your body. Deep dive in and find out how to eat to keep your insides happy.
If you are having swallowing problems get yourself examined. A common mistake doctors make is that they assume it’s in one area only. If the water isn’t coming out of the faucet in your kitchen sink, would you just live without the water if the faucet wasn’t the obvious problem? Of course not. You’d then look at the pipes leading to the faucet. Why wouldn’t you do this for your own health? Your swallow doesn’t stop at the neck. If you do not know the source of your swallowing problem a good place to start is with an ENT (Ear, Nose and Throat) and a GI specialist (aka gastroenterologist) so they can examine your swallow from top (ENT) to bottom (GI specialist). Other sources of swallowing problems can be neurological (e.g., Parkinson’s Disease, stroke, MS), cardiac (due to esophageal compression from a dilated left atrium), or even respiratory. So you may need to see a variety of specialists before you find your underlying impairment. A reputable Speech Language Pathologist (SLP) within swallowing disorders can be an invaluable resource while trying to find these answers.